Office of Global Health, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA.
J Int AIDS Soc. 2023 Aug;26(8):e26146. doi: 10.1002/jia2.26146.
The HIV response has long recognized that certain "key populations" such as individuals in detention, adolescent girls and young women, sex workers, people who use drugs, LGBTQ individuals, migrants and others face higher barriers to access to, uptake of, and retention in HIV prevention and treatment services. One approach to addressing these barriers is the training of community paralegals to advocate for the rights of individuals and to address discrimination in health settings.
Community paralegal programmes have been able to successfully address rights violations that impact access to health services and underlying determinants of health across a range of countries and populations, focusing upon issues such as discrimination and the denial of health services; unlawful detention of outreach workers, sex workers, persons who use drugs and men who have sex with men; and harmful traditional practices and gender-based violence. In addition to resolving specific cases, evaluations of paralegal programmes have found that these programmes increased legal literacy among key populations at risk of HIV and increased understanding of human rights among healthcare providers, resulting in improved access to HIV services. Some evaluations have noted challenges related to the sustainability of paralegal programmes similar to those raised with community health worker programmes more broadly.
To achieve global HIV goals, funding for legal literacy and paralegal programmes should be increased and interventions should be rigorously evaluated. Efforts should target discrimination in access to HIV prevention and treatment and criminalization of key populations, two key barriers to ensuring access to HIV prevention and treatment services.
艾滋病应对工作长期以来一直认识到，某些“关键人群”，如被拘留者、少女和年轻妇女、性工作者、吸毒者、男女同性恋、双性恋、跨性别和其他者（LGBTQ+）、移民等，在获得、接受和维持艾滋病毒预防和治疗服务方面面临更高的障碍。解决这些障碍的一种方法是培训社区法律助理，为个人权利发声，并解决卫生保健环境中的歧视问题。
社区法律助理方案已成功解决了一系列国家和人群中影响获得卫生服务和健康决定因素的权利侵犯问题，重点关注歧视和拒绝提供卫生服务；非法拘留外展工作者、性工作者、吸毒者和男男性行为者；以及有害的传统习俗和基于性别的暴力。除了解决具体案件外，对法律助理方案的评估还发现，这些方案提高了艾滋病毒感染风险高的关键人群的法律知识水平，并提高了卫生保健提供者对人权的认识，从而改善了获得艾滋病毒服务的机会。一些评估指出，法律助理方案的可持续性与更广泛的社区卫生工作者方案所面临的挑战类似。
为了实现全球艾滋病目标，应增加法律扫盲和法律助理方案的供资，并对干预措施进行严格评估。努力应针对获取艾滋病毒预防和治疗方面的歧视以及将关键人群定罪这两个关键障碍，以确保获得艾滋病毒预防和治疗服务。
